[stoczko]

#27800

Dear Dr Corenman:

I was involved in a vehicle accident last Mar. I was 61 in age then. I was hit in the rear on a highway twice. The first driver hit at over 100 mph. with me going 50mph. I’m then unconscious and 300 yds. down the highway when hit by the second driver going 66 mph. with me stopped.
The damage was a C1 and C2 dislocation fracture (the pivot bone was shattered), C3-C6 SP fracture, C7 bilateral lamina fracture, seven fractured ribs, fractured right shoulder, left kidney hematoma and left bruised pelvic bone. My physical state after the accident and prior to the surgery was complete arm paralysis and some leg movement. I’d regained consciousness at the hospital emergency room. The surgery was performed within hours of the accident.
The surgery entailed a C1 and C2 fusion, C3-C6 laminectomy. The C7, I believe, was cleaned up bone-wise but had done its own laminectomy in the accident itself.
Several months later, in a rehab hospital, I recovered normal leg function and regained complete arm and hand motion, but the arms and hands were weak and lacked feeling and/or skin sensation which impaired the use of them.
Just about a year after the accident my arm and hand strength have improved to near normal, but not my skin sensation. Around 9-10 months after the accident I didn’t have enough skin sensation to know when to take a shower or feel pleasure having my back scratched which I do now just about a year after the accident. I now don’t have complete skin sensation in the tips of my fingers and palms of my hands. I must visually see the buttons on a shirt to button them, but can do it.
My problem now is that I have a tightness in my neck, arms, hands, rib cage and calves with a feeling like a mild static electricity shock. It limits my neck mobility. I can’t drive. Both the tightness and shock feeling increased gradually as my skin sensation increased with recovery. I first noticed the tightness in the rehab. hospital about a month and a half into rehab., without the static feeling. The static feeling began with skin sensation and strength returning. Both tightness and static feeling has increased proportionately with strength and skin sensation returning. It’s almost like the feeling one gets in their leg when the crossed legs are hit with the rubber hammer to check reflexes, but involves all the above body parts. I’ve had spells where the above symptoms subside somewhat, but when i engage in any physical activity they increase.
It sounds like what I have is L’Hermitte’s sign? Whatever it is, is there a chance for more recovery in the months ahead or is a year when things are definitively finalized? Could these symptoms spontaneously subside?
My surgical medical care was of outstanding quality, but the follow up info. from other physicians has been rather vague and unspecific. I was told I don’t have the spasticity due to spinal cord damage, which I thought I had. I was prescribed Flexeril to help with sleep interference due to the tightness etc.
Best Regards, Steve T.

.

[Donald Corenman, MD, DC]

#27897

Not sure why you had laminectomies at C3-6 as spinous process fractures generally are benign and generally there is no need for laminectomy unless there is canal compromise. Maybe there is more to it than you understand.

It sounds by your report that you had a spinal cord injury and at least you are regaining motor strength and I assume the ability to walk again. You have dysesthesias from cord injury that will probably continue to improve to a point but you will continue to have some of these abnormal feelings.There is something called allodynia associated with nerve and cord injuries. This is a disagreeable irritation feeling with normal touch. It is very annoying. Possibly can be helped by Neurontin or Lyrica.

You probably need a full workup now with an MRI, X-rays and a CT scan to look at canal compromise and fusion status/instability.

Dr. Corenman

PLEASE REMEMBER, THIS FORUM IS MEANT TO PROVIDE GENERAL INFORMATION ON SPINE ANATOMY, CONDITIONS AND TREATMENTS. TO GET AN ACCURATE DIAGNOSIS, YOU MUST VISIT A QUALIFIED PROFESSIONAL IN PERSON.
 
Donald Corenman, MD, DC is a highly-regarded spine surgeon, considered an expert in the area of neck and back pain. Trained as both a Medical Doctor and Doctor of Chiropractic, Dr. Corenman earned academic appointments as Clinical Assistant Professor and Assistant Professor of Orthopaedic Surgery at the University of Colorado Health Sciences Center, and his research on spine surgery and rehabilitation has resulted in the publication of multiple peer-reviewed articles and two books.

[stoczko]

#27902

Hello Dr.Corenman:
Many thanks for your reply.I do have to make some revisions or updates to my last posting. You might be correct in that there is more to it than I understand.
When I left the rehab. hospital I was by then able to find a discharge paper with what had been sustained in the injury and the remedy for it. As mentioned, it said there was C! C2 dislocation fracture C3-C6 SP fracture and a C7 bilateral lamina fracture. It indicated the remedy was the C1 C2 fusion, the C3-C6 laminectomy and NOTHING about C7 in terms of how its bilateral fracture was remedied. I was basing what I told you on this.
Before the surgery I was shown a lateral neck image in which I could see the shattered pivot, or dense?, bone of the C1 and C2 and the spinous process all looked broken off. I was told I had some degenerative conditions of my neck and could see one of the discs, perhaps around C3, of much less height than the others, the others looking low in height as well compared to what I see in anatomy books etc. The cervical spine was bent forward much more than normal. I wasn’t in any condition then to pick and choose my treatment. Nobody came in my room after the surgery to tell me anything, except for one of the surgeons telling me immediately after the surgery that my spinal column was in beautiful condition and I would recover fully and not to turn my head side to side, all of two minutes. I’m wearing a collar.
Later at the non-surgical, rehab. hospital I had lateral and front X-Rays taken. Drs. there said all was fine. I eventually brought these X-Rays home on a disc.
Some time later, before going home I left the rehab. hospital to see the same surgeon for the first follow up visit. A front and lateral view x-ray taken and I’m told all was fine and that it takes a year, but most everyone is 90% of what they were at a year. I’m told to not wear my collar any longer and my primary care Dr. was sent a letter stating that there were NO neck motion restrictions and ANY physical therapy would be appropriate, and I’m to return six weeks later for another follow up visit.
I’m now home with no physical therapy assigned and I return for the next surgical follow up visit, now 3 1/2 months after the accident.
Contradicting the last visit, I’m told by the same surgeon that most people see just about all their improvement after three months and I wouldn’t fully improve; and I must not to turn my head side to side or the hardware might pull out; and I’m not told how long I must not turn my head, that was going to the too much time. I’m told not to come see them again unless I have a problems and the visit is over.
A good six months after the surgery I get a letter from the rehab. hospital to see a physiatrist, which I did. The Dr. tells me to turn my head up and down and side to side, pricks my hands and feet with a needle and asks me if I knew where I was. She assigns me outpatient physical therapy for nine 1/2hr. sessions over two months, which didn’t achieve anything, and I’m given home exercises to follow which I’ve done. One interesting comment made by the therapist was that the only laminectomy performed according to my records given her was the C7 that had the bilateral Lamina fracture.
I looked at the X-rays taken home on a disc from the rehab. hospital. On the lateral view I could see that all of the Spinous Processes were missing and the C1 and C2 hard-wared together. The facet joints were all there, but I couldn’t see if the Lamina at C3-C6 were removed or not as they might be obscured by the facet joint?
I am guessing they left the C3-C6 Lamina there; just having done the fusion of C1 and C2; and The C7 laminectomy, due to it being fractured and not save-able, essentially the accident having done the laminectomy. I suspect they removed the broken off C3-C6 Spinous Process and since they are part of the lamina they call it a “laminectomy” when it’s really a partial one.
My neck cervical spine has/had a reverse to the normal forward curvature, I forget the name of the normal curvature. I’m hoping it has reversed to the normal configuration.
One more thing, I wasn’t operated on within hours of the accident. Looking at bills and some “patient portal” notes, it was four days later. The accident on a Thursday, the surgery on Monday.
My symptoms don’t involve any pain or irritation at being touched.
What I have it a tightness of the neck and shoulders, rib cage and calves, that feel like I’m lifting weight when I’m not. My walking is fine but I have a spring in my step due to the tightness in my calves. I can walk fast for miles. It is the same exact group of muscles that would tighten whenever I would take an ice cold shower when my water heater was broken. The palms of my hands and finger tips feel like a mouth that is about 80% woken up after novocaine is given for dental work. I was given neurontin in the rehab hospital for pins and needles, which I never had anyway, and it had no effect on this.
I just wonder where I’ll be with this? I’m uncomfortable but not in any pain or state of irritation. The physiatrist told me that any tests such MRIs wouldn’t reveal anything as nerves can look fine one day. but not the next though still improving?
My plan is to sit tight for another six months or so and then see where I am. Does that sound OK? I’m not getting worse in any way. I’m quite perplexed and worried.
Best Regards, Steve T.

[Donald Corenman, MD, DC]

#27937

You need a spine surgeon to go over your current status and tell you what’s going on. It sounds like you had a central cord syndrome and are partially recovered (see https://neckandback.com/conditions/spinal-cord-injuries-neck/).

You have a fusion of most of your vertebra in your neck including C1-2 which is responsible for 50% of your neck rotation (with the other 50% generated from the C2-7 vertebra which are fused). Your neck will feel stiff and achy due to the immobility. If you were fused in flexion (lordosis is the normal alignment which is a backwards curve), this will put more stress on your shoulder/neck muscles to keep your head upright.

You should be fused at this time but I would recommend a CT scan to make sure you have a solid fusion and there are no segments that are “loose”

Dr. Corenman

PLEASE REMEMBER, THIS FORUM IS MEANT TO PROVIDE GENERAL INFORMATION ON SPINE ANATOMY, CONDITIONS AND TREATMENTS. TO GET AN ACCURATE DIAGNOSIS, YOU MUST VISIT A QUALIFIED PROFESSIONAL IN PERSON.
 
Donald Corenman, MD, DC is a highly-regarded spine surgeon, considered an expert in the area of neck and back pain. Trained as both a Medical Doctor and Doctor of Chiropractic, Dr. Corenman earned academic appointments as Clinical Assistant Professor and Assistant Professor of Orthopaedic Surgery at the University of Colorado Health Sciences Center, and his research on spine surgery and rehabilitation has resulted in the publication of multiple peer-reviewed articles and two books.

[stoczko]

#27941

Hello Dr. Corenman:
Thanks for your reply. Supposedly the only fusion was the C1 and C2. The C3 -C6 discs and joints weren’t fused, no hardware exists on them, discs weren’t removed, but it isn’t clear to me if C3 -C6 had laminectomy or not. The x ray I have isn’t very good quality. The C7 lamina had the bilateral fracture which definitely means that vertebra had laminectomy. I can tilt my head up and down as much as before the injury and stand straight, which I would think means I may have the normal lordosis curve back.
I’m just curious why you mention that C3 -C6 had fusion performed?
Best Regards, Steve T.

[Donald Corenman, MD, DC]

#27942

If you had laminectomies without fusion at the lower vertebra, you are at risk for a kyphosis (bending forward) of your neck as the structures either fractured or removed (or both) are important as a tension-band to restrict forward flexion.

I was under the assumption that you had a fusion in the lower neck as if you had laminectomies without fusion simply because you had spinous process fractures without canal compromise, this would predispose you to a kyphosis situation. You would need, in my opinion, strengthening of the extensor muscles (in the back of the neck) to fight the tendency for forward flexion.

Dr. Corenman

PLEASE REMEMBER, THIS FORUM IS MEANT TO PROVIDE GENERAL INFORMATION ON SPINE ANATOMY, CONDITIONS AND TREATMENTS. TO GET AN ACCURATE DIAGNOSIS, YOU MUST VISIT A QUALIFIED PROFESSIONAL IN PERSON.
 
Donald Corenman, MD, DC is a highly-regarded spine surgeon, considered an expert in the area of neck and back pain. Trained as both a Medical Doctor and Doctor of Chiropractic, Dr. Corenman earned academic appointments as Clinical Assistant Professor and Assistant Professor of Orthopaedic Surgery at the University of Colorado Health Sciences Center, and his research on spine surgery and rehabilitation has resulted in the publication of multiple peer-reviewed articles and two books.

[Author]

Posts